Loading...
HomeMy WebLinkAbout2025-00049638 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets Mil lli 11 IIII 0111011001011111 HIIIIOII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003909175 u, 1 U21 3 4 1 U1 2 U2 1 U, 1 u2 1 u1 99 U2 99 2 10 u1 4 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00049638 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n HIGGINS RD El In04:59 ® ❑ RELATED ®Y 0 N 08 01 2025 ®AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ❑PM FLOW CONDITION m FT!MI N E S W N RANDALL RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 C) FRorar TOWED U1 Q Laketic. Rajko Ford Fusion 2014 00-NONE 2 , DUE TO CRASH ❑ EN O NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE ©i - FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 THERDISTRACTED ❑ 0U2 4 M M 2 4 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il_6 I,.4 COM VEH ❑ jg! 1 0 I— 60110 0 1 0 FIRST CONTACT 10 7 • _5 *IIYes.See Sidebar U1 Z AW47880 I L 2026 REAR TELEPHONE IL D 3FA6P0G70ER372914 Geico ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 1 99 9 Laketic. Milos 6054-17-76-69 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 XI g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 New 0 NCv 0 DV /1 9 9 5 Nissan Altima 2008 00-NONE i1_"j t2..-_, DUE TO CRASH ❑ 2 x oYr 13-UNDER CARRIAGE 16'1 c., 2 FIRE ❑ U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,,6.7OPO3 * X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN POINT OF 8 Oistracii n value 9 g i1 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 _,,_ COM VEH ❑ ® U1 COFIRST CONTACT 3 7 . -5 •It Yes.See Sidebar — Elgin IL 60120 0 1 0 DM77265 IL 2026 I 0 C IL D 1 N4AL24E18C105501 American Alliance ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 1 99 9 Same I LAA096150200 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 3 02 / U1 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 11 1 08,01 /2025 04 59 ®❑PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 v 2 0 2 28 08,01 ,2025 05 01 ❑pM El Construction >F R O 0 xi CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ®AM ❑Maintenance U2 -a, o ARREST NAME Laketic. Rajko 11-1427.4- 1553-000155 08/01 /2025 05 07 0 pM SLMT iglSECTION CITATION U 1 ® 0 Utility11 • CITATIONS ISSUED 0 PENDING NO. ROAD CLEARANCE TIME rnAM r 2 El ARREST NAME Zeldon-Rodriguez.Jading.J. 6-101 1553-000154 08/01 /2025 05 39 0 PM 0 Unknown work zone type U1 45 2 2 3 El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1553-Jentsch.Clarissa 901 08 ,26/2025 09 00 ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< INDICATE NORTH —I BY ARROW combination):or 2 Is used or designed to transport more than 15 passengers including the driver C N/f 4 I 1 `E t I 1♦ , - (example:shuttle or charter bus):or ` Nof To Scala ., - 3. Is designed to car 15 or fewer passengers and operated a contract carrier O d of r! - } } } transporting employees in the courses of their employment(example:employee X �� transporter-usually a van type vehicle or passenger car):or w L L.___a__._J nT - 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver. C I � ? _ �•• } } } for direct compensation(example:large van used for speific purose):or L L--_-a-___.i. mamma y t i i I 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires Y -u placarding(example:placards will be displayed on the vehicle). XI ♦ ♦ —1 — — — CARRIER NAME Z ♦ ♦ O ADDRESS D V1 1 .1. 1 .1. h 1 1I 1 CITY/STATE/ZIP o iI - i. 4. MOTOR CARR.ID ElInterstate ElIntrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m 'LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Silver u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Amiss/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE